Researchers at Wake Forest School of Medicine in Winston-Salem, NC, noted in the paper that type 2 diabetes is a progressive, incurable disease, but that it is possible to achieve remission — defined as a return to prediabetes or nondiabetic fasting glucose levels, which are levels below 100 mg/dL. Patients in remission also no longer need diabetes medications, such as metformin.

Over the four-year observational analysis, which included more than 4,000 adults with type 2 diabetes, participants who received intensive lifestyle interventions lost significantly more weight than those in the control group and measured greater fitness improvements. At the end of the trial, 9.2 percent of those in the intensive lifestyle intervention group achieved partial or complete diabetes remission while less than 2 percent of the control group achieved partial or full remission.

The key to this success, researchers said, was participation in weekly diabetes care sessions in the first six months post-diagnosis, followed by three sessions per month for six months and bimonthly sessions for the next two years. By comparison, those in the control group were involved in only three sessions on diabetes care per year.

Despite the success of some participants, researchers noted that complete remission was rare and the intensity of the lifestyle intervention studied was far greater than that available to most people with type 2 diabetes today.

"In spite of these limitations, this is the largest study to our knowledge to examine the association of a lifestyle intervention with type 2 diabetes remission," the authors wrote in JAMA. "Our findings suggest that an intensive lifestyle intervention may be associated with a partial diabetes remission in a subset of patients with type 2 diabetes, particularly those whose diabetes is of short duration, who have lower [fasting glucose levels], and who do not yet require insulin therapy."

This is not the first study to find that intensive diabetes management might be the key to optimal health. In 1993, the landmark Diabetes Control and Complications Trial clearly demonstrated that metabolic control is essential for people with type 1 and type 2 diabetes, which raises a question: Should intensive therapy be implemented for the 26 million Americans with diabetes, as well as the more than 70 million who are prediabetic?

In a linked commentary in this most recent study, researchers not primarily connected with the data argue that intensive interventions are also needed for prediabetics and for the population of overweight or obese children.

"Research, education, and policy efforts need to be focused further upstream, toward primary prevention: reducing incident obesity in children, adolescents, and adults, especially among those with a family history of obesity or diabetes," researchers David E. Arterburn, MD, MPH, from the Group Health Research Institute in Seattle, Wash., and Patrick J. O'Connor, MD, MPH, from HealthPartners Institute for Education and Research in Minneapolis, Minn., wrote in the commentary. "Prevention of diabetes and obesity should be a rallying cry for all clinicians who care about the health of the nation."

TELL US: Have you used lifestyle counseling to help you manage your diabetes? Share your experiences in the comments. (Note: Mobile users won't be able to comment.)

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